TO FINISH MY COMMENTS ABOUT THE FAILURE TO EVEN MENTION FRAUD AND OVERSIGHT IN DEVELOPING THIS 'MODEL' PILOT FOR MEDICAID PATIENTS I WANT TO REMIND EVERYONE THIS IS A HUGE FUNNELING OF TAXPAYER MONEY TO THE TOP.....THIS IS WHAT CREATED INCOME INEQUITY AND WE ALL NEED TO SHOUT LOUDLY AND STRONGLY FOR LAWS AND ENFORCEMENT! I WILL COMMENT NEXT TIME ON POINTS MADE BY OTHERS AT THIS MEETING. YOU MAY NOT THINK ONE MEETING IS IMPORTANT, BUT YOU CAN SEE IMPLIED AND SYSTEMIC PROBLEMS IN JUST ONE 2 HOUR MEETING.WE HAVE SHOWN THAT WATCHDOG GROUPS ESTIMATE $80 BILLION IN MEDICARE FRAUD A YEAR AND MEDICAID FRAUD IS FAR HIGHER SO IT IS SAFE TO SAY THAT EACH STATE HAS BILLIONS OF ENTITLEMENT FRAUD A YEAR. S0 WE ARE TALKING A HEALTH INDUSTRY.....AND IT IS MOSTLY BUSINESSES, NOT INDIVIDUALS THAT TAKE THIS MONEY.......THAT IS ACTING LIKE A CRIMINAL CARTEL, JUST LIKE THE BANKS. WE WATCH AS YOUR POLITICIAN AND MINE REFUSES TO WRITE TOUGH FRAUD LAWS FOR BANKS AND NOW, WITH HEALTHCARE BEING HANDED TO WHAT WILL BE HUGE UNMONITORED COROPORATIONS COMING FOR MEDICAID, AND SOON TO BE MEDICARE BUSINESS BEING PUSHED FROM MAINSTREAM HOSPITALS AND DOCTORS OFFICES INTO A SEPARATE SYSTEM WITH EVEN LESS OVERSIGHT. IT IS NOT HARD TO SEE WHERE THE CHANCE FOR FRAUD ESCALATES. BELOW YOU SEE HOW THE FEDERAL GOVERNMENT THINKS IT IS GREAT THAT $4 BILLION OF PROBABLY $150 BILLION EACH YEAR WAS RECOVERED. MARYLAND ANNOUNCED TENS OF MILLIONS RECOVERED FOR WHAT WE KNOW IS BILLIONS JUST HERE IN THE STATE. THIS IS A SERIOUS RACKET AND IF WE DO NOT ELECT POLITICIANS WHO WILL REVERSE THIS ........THE INCOME INEQUITY FROM FRAUD WILL GROW AS WE LOSE ALL OF OUR QUALITY OF LIFE.YOU SEE BELOW THAT MARYLAND DOESN'T HAVE EVEN A CURSORY SET OF FRAUD LAWS IN PLACE FOR HEALTH CARE FRAUD. THE ATTORNEY GENERAL DOUG GANSLER WILL SAY THERE IS NOTHING HE CAN DO .......THERE ARE NO LAWS BROKEN.......BECAUSE THERE ARE NO LAWS WRITTEN!VOTE YOUR INCUMBENT OUT!!!THIS IS ANTHONY BROWN MOVING FORWARD AND LEAVING YOU UNPROTECTED.......AS ARE ALL OF MARYLAND'S POLITICIANS!________________________________________________HERE IS OBAMA BEING PROUD OF A TINY PIECE OF FRAUD RECOVRY.....REMEMBER, HE AND GANSLER DIDN'T SEE ANY OF THE TRILLIONS IN FINANCIAL FRAUD THAT WAS WELL DOCUMENTED BY WATCHDOG GROUPSFOR IMMEDIATE RELEASEJanuary 24, 2011 Contact: HHS Press Office (202) 690-6343 Health care fraud prevention and enforcement efforts recover record $4 billion; new Affordable Care Act tools will help fight fraud Joint DOJ & HHS efforts result in largest sum ever recovered in single year; new rules under the Affordable Care Act will keep fraudulent providers and suppliers out of Medicare, Medicaid, CHIP and avoid payments of fraudulent claims_______________________________________________HERE WE SEE MARYLAND MISSING BASIC AND IMPORTANT LAWS THAT WOULD ALLOW FOR FRAUD CHARGES. THIS IS WHAT MAKES MARYLAND THE MOST CORRUPT AND FRAUDULENT STATE IN THE COUNTRY.Maryland: Health Care Fraud Compare Maryland to: United States Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Health Care FraudStates that have Enacted a False Claims Act, 2009MD USState has enacted a False Claims Act (FCA) No 32+DC Yes FCA with qui tam provisions No 23+DC Yes FCA applies to Medicaid Only No 6 Yes FCA meets DRA requirements No 14 Yes State False Claim Acts (FCAs) are state-level extensions of the Federal False Claims Act, 31 U.S.C. 3729-3733, which stipulates that those who knowingly submit, or cause another person or entity to submit, false claims for payment of government funds can be held liable for the governments damages plus civil penalties. False Claims Acts contain qui tam, or whistleblower, provisions that allows citizens with evidence of fraud against government contracts and programs to sue on behalf of the government in order to recover the stolen funds - a portion of which may be awarded to the whistleblower. Qui tam suits remain under seal for at least 60 days during which the Department of Justice can investigate and decide whether to join the action.The Fraud Enforcement and Recovery Act (FERA) was enacted in 2009 and further strengthens the FCA by broadening the range of conduct that can be subject to false claims prosecution by including the presentment of a false claim (even if not paid) and the knowing use of false records or statements related to a false claim. In addition, under FERA’s expanded definition of what constitutes a “claim,” the false invoice or statement no longer must be presented directly to the federal government in order to establish liability; it is sufficient merely if the money is to be spent on the Government’s behalf.The Deficit Reduction Act (DRA) of 2005 S.1932 contained provisions encouraging states to enact their own False Claims Acts by granting to states with FCAs that meet federal standards a portion of any federal Medicaid funds recovered throughMedicaid-related actions brought under FCAs. In 2008, an estimated $2.1 billion will be recovered through FCA claims, the vast majority of which are based on provider fraud. For more information, see http://www.taf.org/.Sources: Health Care Fraud, Sara Rosenbaum et. al., George Washington University School of Public Health and Health Services Department of Health Policy, October 2009, State Health Care Fraud Laws, 2009MD USState has False Claims Act No 32+DC Yes State has Anti Kickback Laws No 36+DC Yes State has Self-Referral Laws Yes 34 YesThe Anti-Kickback Statute makes it a criminal offense to knowingly and willfully offer, pay, solicit, or receive any remuneration (kickback, bribe, or rebate) to induce or reward referrals of items or services reimbursable by a federal health care program. The statute is violated if remuneration is paid purposefully to induce or reward referrals of items or services payable by a federal health care program (e.g., if a hospital makes payments to a medical practice to incentivize referrals of its Medicare business). The statute has several exceptions and the Department of Health and Human Services has promulgated safe-harbor regulations shielding certain activities such as employment relationships, investment interests, certain referral services, and other types of payments that are not considered remuneration for the purpose of the Act.37 states and the District of Columbia have anti-kickback laws. These laws are either general in application or Medicaid specific. State anti-kickback laws usually apply to all payers while the federal statute only applies to payments related to federal health care programs. States’ anti-kickback statutes vary widely, are usually not modeled after the federal law, and often lack the intent requirements of the federal law. Medicaid-specific anti-kickback laws, by contrast, typically are modeled after federal law, although there can be variation, both among states and within a state, by service. State laws vary in the extent to which they include the types of safe harbor provisions found in the federal statute. For example, the federal Anti-Kickback statute exempts remunerations paid by an employer to a bone fide employee; on the other hand, Florida’s anti-kickback statute does not. The relatively broad nature of many state anti-kickback laws makes state level enforcement much easier, as it requires less proof than required at the federal level. However, at least one state court has held that a state anti-kickback law is preempted by federal anti-kickback law.Self-Referral Laws are often referred to as “mini-Stark” laws and have been enacted in 34 states. Laws, that restrict self-referral by health care providers, vary by jurisdiction, but in general they fall into three main categories: 1) laws that are nearly identical to Stark laws applied to state programs; 2) laws that prohibit all self-referrals; and 3) laws with a disclosure requirement of financial interests to patients. In a number of cases, state mini-Stark statutes simply incorporate the terms of the federal law by reference.In the case of state laws that ban all self-referrals (and are thereby more stringent than the federal self-referral statute), physicians are banned from any ownership interest in hospitals or other facilities to which they refer their patients. State statutes requiring only disclosure vary widely across the states, but most require disclosure in writing to the patient. Whatever forms the state self-referral laws take, some state statutes may reach self-referrals not covered by the federal prohibition. State law may extend to “referrals paid for by payors other than Medicare and Medicaid, referrals by practitioners other than physicians, and referrals for services other than those designated by the federal law.” In contrast, other state laws are more flexible than the Stark laws in providing broader exceptions to prohibitions on referrals.

________________________________________________HERE IS THE PUBLIC MEETING IN WHICH LEADERS FROM THE STATE TRIED TO PRETEND MARYLAND HAS NO PROBLEM IN FRAUD AND TOOK EXCEPTION THAT FRAUD NEEDS TO BE A CORNERSTONE TO ANY MODEL FOR HEALTH REFORM LIKE THESE HEALTH ENTERPRISE ZONES.Wednesday, Jul. 18, 2012 State health initiative aims to decrease disparities Will try to put more doctors in underserved areas by JEFF NEWMAN, At a forum Wednesday on a new state initiative on Health Enterprise Zones at the Jaycees Center in Waldorf, Frances Phillips, deputy secretary of public health services for Maryland, and Mark Luckner, executive director of the Maryland Health Community Resources Commission, explain the program.

A new state law passed during the 2012 legislative session budgets $4 million in the current fiscal year to create and support two to four “health enterprise zones” in areas with existing health disparities among minority groups.Through proposed incentives like income tax credits, student loan assistance and grant funding, the four-year pilot program aims to reduce disparities by attracting physicians to underserved areas.The goal is to both increase access to health care and reduce costs by getting people to visit a personal care provider rather than hospital emergency rooms, Maryland Department of Health and Mental Hygiene Deputy Secretary Frances B. Phillips said at the forum.Phillips and Mark Luckner, executive director of the Maryland Community Health Resources Commission, spent most of the forum explaining the program, but figures presented by Dr. David A. Mann, an epidemiologist with the department’s Office of Minority Health and Health Disparities, made the case for why such a program was needed.The data showed African-Americans in Maryland are twice as likely as whites not to have health insurance, suffer from rates of infant mortality, late prenatal care and end-stage kidney disease at three times the rate of whites and contract HIV nearly 12 times as often as whites.Other data showed little disparity in the mortality rates of whites and blacks suffering from heart disease and cancer in the three Southern Maryland counties, but great variances in the number of emergency room visits related to diabetes, hypertension and asthma.The rate of diabetes-related ER visits for blacks was five times higher than for whites in St. Mary's County and four times higher in Calvert County.In Charles County, blacks went to the ER for diabetes, high blood pressure and asthma at double the rate of whites.“Something’s going on with the black patients that’s not going on with the white patients,” Phillips said.But the Charles County data also show a slightly higher percentage of black adults were of a healthy weight and that the rate of smoking was lower among blacks.In combating these disparities, Phillips said solutions would be found locally.“In terms of helping communities become healthier, that doesn’t happen in Baltimore,” she said. “It absolutely happens in counties, in coalitions like this and through the kinds of groups that you all represent. This is where the real work gets done. This is where the real partnerships are.”Modeled after programs such as the Harlem Children’s Zone and Promise Neighborhoods, the health enterprise zones were the chief recommendation for reducing health disparities made by a workgroup established by Lt. Gov. Anthony G. Brown (D) and chaired by University of Maryland School of Medicine dean Dr. E. Albert Reece.The workgroup issued a report in January which cited higher rates of certain diseases — particularly asthma, diabetes and high blood pressure — among minority groups.“Every Marylander, of every race, ethnicity and nationality, in every part of our state, should have the chance to live a healthy, productive life,” Brown said in a statement after legislation authorizing the program passed in April. “With our Health Enterprise Zone program, we will be able to saturate underserved communities with primary care and other health services to help reduce rates of chronic and often preventable illnesses, such as hypertension, asthma, diabetes and other controllable medical conditions.”Each zone must be made up of a contiguous cluster of ZIP codes with at least 5,000 residents and have documented evidence of health disparities, economic disadvantage — as evidenced by high rates of Medicaid enrollment or participation in the federal Special Supplemental Nutrition Program for Women, Infants and Children program — and poor health outcomes like lower life expectancy or higher rates of low-birth-weight infants.“These two to four HEZs, that’s just the start, and we really are looking at this as an incubator to attract investment to really all kinds of supplemental programs from other sources beyond state funding,” Phillips said.Phillips mentioned Sen. Thomas “Mac” Middleton (D-Charles), who co-sponsored the legislation, as one of those critical to getting the bill passed. “There is no finer champion of rural health,” she said of the senator.Middleton, who did not attend the forum, said the greatest incentive that can be offered to physicians is student loan forgiveness, noting that medical students often graduate with more than $150,000 of debt at ages where they are looking to settle down, get married and buy new cars and homes.“Loan forgiveness becomes a very critical piece of getting doctors to come to these underserved areas,” he said.Middleton also said that he was assured by Gov. Martin O'Malley’s (D) administration that rural regions like Nanjemoy would be able to get some assistance even if they are not specifically included in a health enterprise zone.To be selected for an HEZ, applications need to outline the community’s health needs, identify specific diseases where disparity exists, propose measurable goals and strategies to meet them, exhibit balance between community-based and primary care solutions and showcase a local coalition of providers and organizations, according to material Luckner presented at the forum.The department and commission are accepting public comments on the program’s eligibility requirements, application review principles and provided benefits.Comments may submitted until July 31.The HEZs will be selected in the fall and winter, with implementation scheduled to being in December.jnewman@somdnews.com